Provider Demographics
NPI:1013055151
Name:KRISTAL HILL INC
Entity Type:Organization
Organization Name:KRISTAL HILL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:479-996-5202
Mailing Address - Street 1:170 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-4965
Mailing Address - Country:US
Mailing Address - Phone:479-221-3050
Mailing Address - Fax:479-996-5202
Practice Address - Street 1:170 AZALEA DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-4965
Practice Address - Country:US
Practice Address - Phone:479-221-3050
Practice Address - Fax:479-996-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X615OtherBLUE CROSS BLUE SHIELD ID